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The full report is titled “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 6 August 2013 issue of Annals of Internal Medicine (volume 159, pages 210-218). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.

Who developed these recommendations?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Alcohol misuse can hurt relationships; increase risks for accidents and violence; and cause problems with the liver, brain, and heart. Several levels of misuse exist. “Risky alcohol use” is defined as more than 7 drinks per week or more than 3 drinks per occasion for women and more than 14 drinks per week or more than 4 drinks per occasion for men. This level of drinking puts people at risk for future problems. “Harmful alcohol use” damages physical or mental health. “Alcohol abuse” leads to repeated failure to meet home, work, or school responsibilities; use of alcohol in physically dangerous conditions (while operating heavy machinery); or alcohol-related social or legal problems. “Alcohol dependence” is defined by physical cravings for alcohol and withdrawal symptoms.

In 2004, the USPSTF recommended that doctors screen all adult patients in primary care settings for alcohol misuse and provide brief counseling for identified risky or harmful drinkers. The USPSTF wanted to update the recommendations on the basis of new information that has become available since 2004, particularly information related to screening adolescents.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research about the benefits and harms of screening and counseling for alcohol misuse.

What did the authors find?

The USPSTF found good evidence that screening adults can accurately identify patients whose alcohol use does not meet criteria for abuse or dependence but is “risky” or “harmful” and puts them at risk for future alcohol-related health problems. Several standard questions can help identify people who have alcohol problems. They include asking about the frequency and typical quantity of drinking, frequency of exceeding recommended drinks per occasion, drinking first thing in the morning, feeling guilty about drinking, feeling a need to cut back on drinking, and feeling that others are criticizing your drinking. They also found good evidence that brief counseling will reduce alcohol misuse in these types of adult drinkers over the next 6 to 12 months and maybe even longer. The authors did not identify harms of screening or counseling that would outweigh the potential benefits. The evidence for screening and counseling adolescents was limited.

What does the USPSTF recommend that patients and doctors do?

Health care providers should screen adults aged 18 years or older for alcohol misuse and provide brief behavioral counseling to reduce alcohol misuse for patients with risky or harmful drinking.

Current evidence is insufficient to judge the balance of the benefits and harms of screening and behavioral counseling in primary care settings to reduce alcohol misuse in adolescents.

What are the cautions related to these recommendations?

These recommendations may change as new studies become available. Also, they do not apply to people with signs and symptoms of alcohol abuse or dependence or those who are actively seeking care for alcohol-related problems.

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